Glossitis

Description

• An acute or chronic inflammation of the tongue, either as primary disease or a symptom of systemic disease
• Common forms:
  • Atrophic glossitis (AG) or Hunter glossitis or smooth tongue
  • Benign migratory glossitis (BMG) or geographic tongue (GT) or erythema migrans or annulus migrans
  • Median rhomboid glossitis (MRG)
  • Herpetic geometric glossitis (HGG)
• System(s) affected: gastrointestinal (GI)

Epidemiology

Predominant age: all ages; predominant gender: male > female (3:1, MRG)

Geriatric Considerations
Many patients with glossitis caused by nutritional deficiencies are postmenopausal or elderly.

Prevalence
Varies; usual reported range: 1–14%; higher with nutritional deficiencies

Etiology and Pathophysiology

• Systemic
  • Nutritional deficiencies (e.g., vitamin B₁₂, folic acid, ascorbic acid)
  • Anemia (pernicious, iron deficiency)
  • HIV (opportunistic infections such as candidiasis [MRG], herpes simplex virus [HSV]; or HIV-associated changes such as loss of papillae)
  • Broad-spectrum antibiotics
  • Topical or inhaled corticosteroids
  • Various other medications (e.g., captopril, clarithromycin, enalapril, lansoprazole, lithium, metronidazole, NSAIDs)
• Local
  • Infections (e.g., HSV, Epstein-Barr virus, candidiasis)
  • Trauma (ill-fitting dentures, piercings, burns, convulsive seizures)
  • Primary irritants (alcohol, tobacco, hot foods, spices, excessive peppermint, citrus)
  • Sensitization with chemical irritants (e.g., dyes, mouthwash, toothpaste, systemic drugs)
  • Malignancy (95% are squamous cell)
• Tongue
  • AG: atrophy of filiform papillae
  • BMG: erythematous, yellow-white lesions (dorsum)
  • MRG: atrophic filiform, plaque-like lesions (midline)
  • HGG: linear fissures (dorsum)

Genetics

• Familial history may be present with BMG.
• GT and psoriasis share a common genetic marker.
• One recent small study has suggested that some GT cases may be true oral psoriasis, whereas others are only GT.

Risk Factors

• Poor nutrition
• Dentures
• Piercings
• Allergic background (e.g., asthma, eczema, hay fever)
• Smoking, smokeless tobacco
• Alcoholism
• Anxiety, stress
• Depression
• Hormonal disturbances
• Oral contraceptives
• Advancing age
• Immunocompromised state

General Prevention

• Evaluation of nutritional status, including vitamin B deficiencies, anemias
• Cessation of tobacco use (including smokeless)
• Assess for irritation from teeth, dentures, or piercings.

Commonly Associated Conditions

• Fissured tongue (BMG)
• HIV infection (rare)
• Reiter syndrome (rare)
• Down syndrome (rare)
• Crohn disease (rare)
• Celiac disease (possible correlation)
• Psoriasis (possible correlation)